Assessments with Alcohol on Board Washburn County HHSD/Northwest Connections Shell Lake, Wisconsin Change Team Members: Jim LeDuc, Iris Ostenson, Telephone/Mobile Crisis Teams

AIMs Big Aim: Reduce re-hospitalization Little Aim: Identify and reduce the inappropriate use of Chapter 51.15(ED) hospitalizations for crisis situations where alcohol is a primary issue. By reducing these hospitalizations we will be reducing hospitalization in general, which contributes to the big AIM. Reviewed data over the last three years and identified many of the ED cases also had AOD concerns on board Conducted case by case review for the first three quarters of 2012 We wanted to identify “was alcohol prevalent and the leading issue in the majority of these cases.?” We began reviewing each case that resulted in an ED that had alcohol on board for appropriateness and those that had alcohol on board that did not result in an ED –what was done differently? What we identified is that if we could hold the assessment process until the person was no longer incapacitated by AOD, we would be better able to assess for acute inpatient care needs

Change Plan Increase assessment content to better explore primary issue at time of contact(MH, alcohol, drug, etc) Delay the detention and admission process with individuals who’s primary issue at the time of contact is alcohol/drug intoxication Increase communication with local emergency room departments to accept individuals with alcohol/drug intoxication until they are able to be assessed Increase communication with local law enforcement to take individuals with alcohol/drug intoxication for medical attention until they are able to be assessed Any time that a situation appears to be an ED no community safety plan can be developed, mobile will be sent vs. an over the phone approval

Change Project Data Project Data Quarter 1 Quarter 2 Quarter 3 Number of Crisis Calls 49 42 48 Number of Emergency Detentions 17 8 7 Number of Detentions with Alcohol or Drugs as identified as a primary factor 9 4 1 Number of contacts remained about the same however with change implementation we saw a decrease in not only number of detentions with alcohol/drug as primary but emergency detentions in general. Quarter 1: Reviewed data from previous 3 years Identified small Aim Case by case review Trained staff in new assessment tool Quarter 2: Implemented new assessment tool Case Review LE/Hospital Discussions Quarter 3: Case Review Increase staff guidelines /protocols to match change plans

Adopt, Adapt, Abandon All change methods were adopted The ongoing relationship with hospitals and law enforcement was key in implementation of three of the four changes that were made The new assessment tool not only increased screening for situations with AOD on board but also increased screening for risk and protective factors thus showing the decrease in emergency detentions overall

Impact and Plan Impact Increases validity of assessment process Plan Reduced the number of individuals civil liberties being taken away by placing them on an emergency detention Reduced the number of trips to acute inpatient care facilities Reduce the cost to county systems with un-necessary emergency detentions Increases validity of assessment process Plan On-going collaboration with this team to maintain best practice assessment standards and communication Share this project data and outcome with other counties in this region for possible adaptation